"Recovery" and "Real Change": synonyms or incompatible concepts?

Abstract

The concept of “recovery” in psychiatry stresses the revolutionary idea that mental illness is not incurable. However, the term “recovery” seems linked to the Italian term “recupero” (regain) and suggests that... [ view full abstract ]

The concept of “recovery” in psychiatry stresses the revolutionary idea that mental illness is not incurable. However, the term “recovery” seems linked to the Italian term “recupero” (regain) and suggests that patients recover when they regain something, namely the state of well-being and proper reality testing that characterized them before illness developed.

Nevertheless, studies show that the onset of psychosis often occurs years after the appearance of the first clinical signs. Thus, to which moment of their lives do patients have to back to in order to achieve mental health?

The idea that treatment has to help the patient to regain appropriate behaviour and adequate conscious thoughts, e.g., by curing his/her persecutory delusion, is satisfying from a pragmatic point of view. Yet it appears questionable if treatment aims at real psychic changes, which can prevent relapses.

Discussing a number of clinical cases, the Authors suggest that in order to achieve a full recovery, the patients’ relation to reality – precisely, with human reality – has to change also at an unconscious level.

In fact, patients’ unconscious thoughts in regard to human reality, as they are expressed for instance in dreams, offer appear to be distorted even after their conscious ideas and behaviour have returned to be adequate.

The Authors, who refer to the Human Birth Theory (Fagioli 1972), suggest that this persistence of unconscious “madness” does not express a natural hostility of the unconscious mind towards the reality principle. Instead, it denotes a pathological alteration of the unconscious thoughts, which can be treated.

The Authors discuss the idea that a real and lasting change is based on an internal transformation which occurs primarily at an unconscious level. They also discuss the characteristics of this transformation and how it can be triggered by the therapeutic relationship.